Log in to MyACC
Beta-Blockers for Children With Catecholaminergic Polymorphic VT
Quick Takes
- B1-selective beta-blockers are associated with a higher risk of arrhythmic events in children with catecholaminergic polymorphic ventricular tachycardia (CPVT) compared to nonselective beta-blockers.
- Nadolol is the most appropriate beta-blocker for treating CPVT in children.
Study Questions:
Does the type of beta-blocker (BB) affect the risk of arrhythmic events in children with catecholaminergic polymorphic ventricular tachycardia (CPVT)?
Methods:
The data were obtained from two international CPVT registries. Children with the RYR2 variant under the age of 18 years with a history of syncope or sudden cardiac arrest (SCA) predating the use of a BB were identified. The primary outcome was first occurrence of sudden cardiac death, SCA, appropriate implantable cardioverter-defibrillator shock, or syncope. The secondary outcome was the first occurrence of any of the primary outcomes except syncope.
Results:
There were 329 children with a mean age of 12 years at the time of diagnosis. A nonselective BB (nadolol or propranolol) was used in 216 patients and a B1-selective BB (atenolol, metoprolol, or bisoprolol) was used in 111 patients. During a median follow-up of 6.7 years, the primary and secondary outcomes occurred in 30.1% and 22.5% of patients, respectively. Compared to the nonselective BBs, the primary and secondary outcomes were twice as likely to occur in patients treated with a B1-selective BB (hazard ratio, 2.0 for both outcomes). This difference was driven by nadolol, with no difference between the B1-selective BBs and propranolol when analyzed by itself.
Conclusions:
Nadolol is associated with a significantly lower risk of an arrhythmic event compared to B1-selective BBs in children with CPVT. Nadolol should be first-line therapy in children with CPVT.
Perspective:
This study provides compelling evidence that nadolol is preferable to atenolol, metoprolol, or bisoprolol in children with CPVT. The possible reasons for this are one or more of the following advantages of nadolol: longer half-life, with once-daily dosing and less exposure to risk related to a missed dose; fewer central nervous system–related side effects, resulting in higher compliance; less pharmacokinetic variability; less susceptibility to food-induced changes in bioavailability; and blockade of the peak sodium current, which reduces the risk of delayed afterdepolarizations that can trigger CPVT.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Prevention, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement, Lipid Metabolism
Keywords: Adolescent, Adrenergic beta-Antagonists, Arrhythmias, Cardiac, Atenolol, Death, Sudden, Cardiac, Defibrillators, Implantable, Heart Arrest, Metoprolol, Nadolol, Pediatrics, Risk, Ryanodine Receptor Calcium Release Channel, Secondary Prevention, Syncope, Tachycardia, Ventricular
< Back to Listings
